Wallis治疗腰椎间盘突出症的临床对比研究

Clinical comparative study of Wallis interspinous dynamic stabilization in treating lumbar disc herniation

[目的]探讨Wallis棘突间动态稳定系统治疗腰椎间盘突出症的近期疗效。[方法]回顾性分析2008年7月～2010年7月本院骨科收治的腰椎间盘突出症患者共70例,其中40例行髓核摘除+Wallis棘突间固定(Wallis组),30例行单纯髓核摘除(单纯组)。观察两组患者病变节段术前术后椎间盘平均高度(disc height,DH)及活动范围(range of motion,ROM)的变化、术前术后的疼痛视觉模糊评分法(visual analogue scale,VAS)、下腰痛疾患疗效评分(Japanese Orthopedics Association,JOA)、Oswestry功能残障指数(Oswestry Disability Index,ODI)。术后随访9～34个月,平均(18.24±5.15)个月。[结果]Wallis组术后1周DH值较术前显著增高,且术后末次随访时(平均18.2个月)较术前无显著变化;而单纯组术后1周DH值较术前无显著变化,术后末次随访时较术前减小。Wallis组术后ROM值比术前显著减小(P<0.05),而单纯组则与术前无显著差异(P>0.05)。术后1周两组间的VAS评分、JOA评分及ODI评分无显著差异(P>0.05),术后末次随访时Wallis组优于单纯组(P<0.05)。[结论]Wallis棘突间动态稳定系统与单纯髓核摘除术相比,具有满意的近期影像学及临床效果。

[ Objective ] To compare the short -term outcomes of Wallis interspinous dynamic stabilization device with pos- terior lumbar discectomy for treatment of lumbar disc herniation. [ Methods] This retrospective study included 70 patients with lumbar disc herniation treated in the Department of Orthopedics, Guangdong General Hospital from July 2008 to July 2010. Forty patients underwent posterior lumbar discectomy combined with Wallis interspinous dynamic stabilization, compared with the con- trol group including 30 patients treated with posterior lumbar discectomy alone. The VAS, JOA and ODI were scored to evaluate the clinical efficiency. The disc height （DH） and range of motion （ROM） of the operated segments were recorded to assess the biomechanical changes before and after operation. The mean follow -up period was 18.2 months （ranging, 9 -34 months） . [ Results] At one week postoperatively, the DH of the operated segments improved significantly in the Wallis group, but no change was noted in the control group. At final follow - up （ 18.2 months）, the DH of the operated segments did not change in Wallis group, but decreased significantly in the control group. The ROM decreased significantly in Wallis group （ P 〈 0. 05 ） , but did not change in the control group （ P 〉 0. 05 ） at final follow - up. There was no statistic difference in the VAS, JOA and ODI scores between the two groups at one week postoperatively （P 〉 0.05 ） . But the Wallis group had better results than the control group in each scoring at final follow - up postoperatively （ P 〈 0. 05） . [ Conclusion] Wallis interspinous dynamic sta- bilization device has a satisfying radiographic and clinical short- term outcomes compared with posterior lumbar discectomy.